Deciding on your own to avoid foods to alleviate adverse symptoms should be weighed against the consequences of eliminating dietary factors and their related nutrient profiles. In the case of dairy foods, those consequences could be significant for your health and, given the apparent scale of the avoidance behaviour, for society in the long term.

Improper and self-diagnosis have bad consequences

The symptoms of Lactose Intolerance are straightforward and quite noticeable: gas, diarrhea, cramps, flatulence, and the rumbling of gas through the intestines that’s called borborygmi. Problem is, these are also the symptoms from dozens of problems, ranging from reactions to other foods to some truly serious diseases! The aim of this Italian study was to investigate if self-diagnosis may influence dairy consumption. Results showed that 22.2% of the responders based in Campania (a region in Southern Italy) do not drink fluid milk on a regular basis, and 18.1% drink lactose-free milk mainly to avoid gastrointestinal symptoms. The vast majority of the population chose to avoid milk consumption without undergoing a breath test for lactose intolerance or ask a doctor.

You can still eat dairy, like yogurt!

Talk to your doctor! He can give you an objective and definitive diagnosis. If you have felt digestive problems after consuming milk or another dairy product, it is not necessarily due to the lactose. Furthermore, not all dairy products are the same when it comes to lactose. Yogurt and low lactose options had the particular characteristic of being well tolerated by people who find lactose difficult to digest. Eating at least one yogurt a day gives you part of the calcium (15% to 20%) that your bones need each day throughout your life. So, check with your doctor first!

Source: Zingone  et al., Nutrition journal 2017 ; 33 : 322-325.

Professor André Marette of the Physiology and Endocrinology Department at the Laval University in Canada will explain the impact on health markers: “Is yogurt associated with reduced cardio-metabolic risk factors in children?“. During this talk, he will evaluate the role of yogurt as a nutrient-dense snack and its influence in reducing the risk of developing diabetes and obesity.

Dr. Marette is Professor of Medicine at the Heart and Lung Institute, Laval Hospital, and Scientific Director of the Institute of Nutrition and Functional Foods at Laval University. He also holds a research Chair on the pathogenesis of insulin resistance and cardiovascular diseases (CVD).

Dr. Marette is an international renowned expert on the pathogenesis of insulin resistance and cardiometabolic diseases and his research has advanced the understanding of the physiological and /molecular mechanisms of inflammation, and opened new possibilities for prevention and treatment and type 2 diabetes and CVD. He is also studying how nutrition and functional foods can modulate the gut microbiota to protect against obesity-linked intestinal inflammation, fatty liver disease and type 2 diabetes.

He holds grants from the Canadian Institutes for Health Research, the Canadian Diabetes Association, and the Heart and Stroke Foundation of Canada. Dr. Marette has long-standing experience in leading international research programs, which all have in common the multidisciplinary nature of the teams and the implication of various end-users (e.g. industry, government).

Dr. Marette has received several awards for his work including the prestigious Young Scientist Award of the Canadian Diabetes Association and the Charles Best Award from the University of Toronto for his overall contribution to the advancement of scientific knowledge in the field of diabetes. He has published over 175 papers, and been invited to write several reviews and book chapters. He has been invited to give more than a hundred lectures at various national & international conferences in the last 10 years. He currently serves as Editor-in-Chief for the Am J Physiol: Endo & Metab.

Discover here more about his research on yogurt consumption.

The cause of ovarian cancer is unknown. Current evidence from the American Institute for Cancer Research does not support any association between milk and milk product consumption and an increased risk of ovarian cancer. Some hypotheses indicate that the lactose component of dairy may increase the risk of ovarian cancer through its action on ovarian cells. However, other studies highlight the anti-tumour compounds in dairy foods, especially calcium and vitamin D. Previous research was mainly focused among women of European ancestry.

European versus African Americans

Yet most of this previous research is among women of European ancestry. With African Americans at higher risk of low vitamin D levels and many have trouble digesting lactose, it’s possible these factors do affect African American women, the authors hypothesised. This study analysed data, among participants in a population-based case-control study of ovarian cancer, in African-American women in 11 states. African-American women ages 20 to 79 with newly diagnosed ovarian cancer were compared to healthy, self-identified African-American women. The 490 women diagnosed with ovarian cancer and 656 control participants answered questions on the phone about how much dairy they consumed, how much time they spent in the sun and other lifestyle factors.

Lactose and whole milk are worst

The authors observed that women with the highest intake of whole milk and lactose had an increased risk of ovarian cancer, compared with those who consumed the least. However, calcium intake through food and/or supplement was associated with a decreased associated risk (-49%)of ovarian cancer. No association was found for skim milk, low-fat milk, cheese and yogurt. Some evidence also suggested that women who spent 23 or more hours a week outside during the summer months, had a lower associated risk of ovarian cancer compared to women who spent six or fewer hours outside per week

These findings suggest therefore that a high-calcium, low-lactose diet, and moderate sun exposure in summer months may reduce the risk of ovarian cancer in African–American women.

Professor Luis A. Moreno will open the symposium with a presentation on diet quality and lifestyle factors: “Could yogurt facilitate better eating habits in children?“.

Luis A. Moreno is a Professor of Public Health at the University of Zaragoza (Spain). He is also Visiting Professor of Excellence at the University of Sao Paulo (Brazil).

He did his training as Medical Doctor and his PhD thesis at the University of Zaragoza. He studied Human Nutrition and Public and Community Health at the University of Nancy (France).

He has participated in several research projects supported by the Spanish Ministry of Health, and the European commission (HELENA, IDEFICS, EURRECCA, ENERGY, ToyBox and iFamily).

He has published more than 250 papers in peer reviewed journals. He is a former member of the ESPGHAN Committee of Nutrition.

Discover here more about his research on yogurt consumption.

Many people with Inflammatory Bowel Disease (IBD) report that their symptoms become worse after consuming dairy products. However, research about food and IBD is controversial. A new meta-analysis investigated the lactose maldigestion prevalence in IBD.

Many people with Crohn’s disease (CD) or Ulcerative Colitis (UC) avoid dairy out of fear that it will cause uncomfortable symptoms, such as excess gas, abdominal cramping, and diarrhea. However, not every person with CD or UC is actually lactose maldigester or lactose intolerant, so avoiding all dairy may not be a good option. It could even be counterproductive, because dairy is an excellent source of calcium. This is a particularly important nutrient for people with Crohn’s disease, as certain drug treatments and malabsorption may cause a calcium deficiency.  This literature review was performed to extract data on lactose maldigestion prevalence in IBD.

Dairy restrictions may adversely affect disease outcome

Among 1022 articles evaluated, 17 were included in meta-analysis. Lactose maldigestion in inflammatory bowel disease seems to be determined by ethnicity  in most cases of UC and CD. Intolerance symptoms depend on several parameters besides lactose maldigestion. The study also indicates that dairy foods may protect against IBD. Nutritional consequences of dairy restrictions might therefore impact adversely on bone and colonic complications. Even if someone with IBD is lactose intolerant, it’s also possible to safely consume certain dairy products that contain very little lactose or can digest it. These include fermented dairy products like yogurt.

The authors conclude that further work is needed to evaluate the role of dairy foods in IBD as well on methods to avoid their restriction.

Source: Andrew Szilagyi et al., Nutrition Journal 2016; 15 :67

According to an economic model, applied in the UK, increasing yogurt consumption in the adult population by 100g per day could lead to significant patient benefits through reduction of type 2 diabetes, and substantial cost savings in health care expenditure.

By 2040, 1 adult in 10 (642 million) will have diabetes worldwide and 12% of global health expenditure is spent on diabetes. In the UK, Type 2 diabetes (T2D) accounts for approximately 10% of the total UK National Health Service (NHS) resource expenditure and this figure has been predicted to increase to 17% by 2035/2036! But there is some good news… According to the Chen study, the promotion of yogurt consumption could, in the long term, contribute to a reduction in the prevalence of T2D. Then again, yogurt could be an easy, accessible and cost-effective intervention in such a context. The results of this study seem to support this hypothesis.

One yogurt per day may reduce T2D risk

The purpose of this study was to model the possible reductions in prevalence of T2D and its associated health costs; achievable through increasing yogurt consumption in UK adults from the current mean of 20g/d to 125g/d (125 g is equivalent to one pot daily). The simulation focused on adults over 25 years of age. Their model predicts that this shifting of yogurt consumption would reduce the number of T2D cases by 0.9% which represents 388,000 fewer people in 25 years.

Savings of £2.3 billion over 25 years in the UK

The model also estimated that substantial economic savings to the UK could be achieved on National Healthcare Service: approximately £2.3 billion over 25 years, related to the direct costs and indirect costs of caring T2D. Moreover, a significant gain in quality of life might be achieved: 275,000 QALY’s (quality-adjusted life years*) gained over the general population. If these QALYs were valued at £20,000/QALY as is usually applied by NICE in the UK for approval of therapies, then the NHS should be prepared to pay £5,500m over 25 years for an intervention that would generate the same number of QALYs.

This study highlighted the potential of simple changes in daily habits, like increasing daily yogurt consumption, and how it could generate substantial cost savings, as well as significant health benefit through reductions in the incidence of T2D.

* Quality adjusted life year (QALY): A year of life adjusted for its quality or its value. A year in perfect health is considered equal to 1.0 QALY. The value of a year in ill health would be discounted. For example, a year bedridden might have a value equal to 0.5 QALY. (WIKIPEDIA)

Source: Lenoir-Wijnkoop I et al., BMC Nutrition 2016; 2 : 77.

It’s not hard to imagine that abdominal discomfort, associated with lactose maldigestion or intolerance might impair a person’s sense of well-being and quality of life. Lactose maldigestion and intolerance is yet an important health issue. Why? Because if your doctor identify lactose maldigestion or lactose intolerance as the reason for your abdominal discomfort, maybe you tend to avoid eating dairy foods (milk, cheese, and yogurt). This conditioned reflex can lead to lower consumption of critical nutrients (calcium, vitamin D, proteins) that are important for bone health. This reviewed study found that perceived lactose intolerance or objectively diagnosed malabsorption with the Hydrogen Breath Test – was associated with a lower perceived health-related quality of life.

Self-reported opinion of maldigestion and intolerance to lactose impacts health perception

Researchers in Spain determined the impact of perceived lactose intolerance symptoms and objective-diagnosed lactose malabsorption, on health-related quality of life in a group of 580 adults. Overall, 44% of participants considered themselves tolerant to lactose, while 56% considered themselves intolerant. Believing oneself to be lactose intolerant, influenced the decision to avoid dairy consumption (55% of the self-reported lactose intolerant avoid dairy consumption) more than actually being diagnosed with lactose malabsorption (41% percent of objective malabsorbers avoid dairy consumption). Self-perception of intolerance and objective lactose malabsorption were also associated with lower Quality of Life scores. However, those who reported no problems eating dairy foods perceived themselves to have better health than those who reported symptoms.

Are you an healthcare professional? How you can help

Although from the patient’s standpoint, the experience of unpleasant symptoms may be more important than knowing if their symptoms are a result of lactose malabsorption – it’s important to have an healthcare professional-directed diagnosis to rule out other causes that could be more serious and need treatment. The practical #YINI information sheets on lactose maldigestion and lactose intolerance provide a structured and documented approach to the main questions you tend to encounter in consultations with your patients about dairy products. Check it out!

Source: Caselas F et al., European Journal of Clinical Nutrition 2016; 70 :1068-1072.

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Several media stories and organizations claim that milk and dairy increase risk of chronic diseases, nourishing skepticism among general consumers about the health consequences of eating dairy products. This review aims to answer key questions about dairy and health. It assesses the scientific evidence on dairy intake (butter excluded) and risk of main chronic diseases and all-cause mortality, and show that milk and dairy have their place in a balanced diet.

Milk and dairy associated with less obesity

Type 2 diabetes, cardiovascular diseases, and cancers are major causes of disease-free years in several countries today, and the increasing prevalence of obesity greatly increases the risk of these chronic diseases.

Furthermore, childhood obesity is a major contributor the current obesity epidemic and is often linked with future obesity in adulthood. The authors found that among children, a diet high in milk and dairy products is associated with a reduced risk of obesity. In adults, dairy products consumption improve body composition and facilitate weight loss during energy restriction.

A lower risk of main chronic diseases and a better bone mineral density

The results indicated that fermented dairy products are associated with a reduced risk of type 2 diabetes. Furthermore, a high intake of milk and milk products (200-300mL/day) is associated with a reduced risk of cardiovascular diseases.

Bone mineral density benefits of milk and dairy intake, although no association was found with risk of bone fracture. Milks and dairy intake is also associated with a lower risk of colorectal cancer, bladder cancer, gastric cancer, or lung cancer; the evidence for prostate cancer risk was inconsistent. No association was found between milk, dairy products and all-cause mortality.

3 key questions answered

The article also aimed to answer to three key questions regarding dairy products consumption. It shows that:

• A diet with milk and dairy products provides better health and decreases risk of major disease and all-cause mortality,  than a diet with non or low-content of milk, thus recommending to reduce the intake of dairy products in individuals, who tolerate them, is counterproductive for health.
• It is not justified to recommend the general lactose-tolerant population to avoid the consumption of milk and milk products, as it would be as warning against types of foods, such as peanuts, to which only a small part of the population is allergic to.
• There is a lack of scientific evidence to substantiate that replacing milk and dairy products with plant-based drinks will improve health.

To learn more, read the original article.

Source: Kongerslev  et al., Food & Nutrition Research 2016,60:32527.